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Measuring Up

What data and the patient voice tells us about how our health system is performing.

This week Health Quality Ontario (HQO) releases Measuring Up, our yearly report on how the province’s health system is performing.

This report does not try to cover every aspect of care in the system. Instead we have created the Common Quality Agenda in consultation with health partners and system leaders. The Common Quality Agenda has approximately 40 indicators that span all health sectors and cover everything, from the proportion of Ontarians who wait too long for surgery to the proportion of Ontarians who smoke.

Data in itself is not helpful. However data properly presented, integrated with patient experiences and our own then becomes information that in turn can be internalized to knowledge. Ultimately that knowledge forms the basis upon which we can make changes to improve the system – which is the goal of our report.

Measuring Up should be a tool for improvement. We focus on many opportunities for improvement across the various sectors of Ontario’s health system. For example, we identify timely access to care as one area where the health system must improve. Many sectors across Ontario’s health system are not hitting provincial targets.

Some important findings include:

Sixty percent of Ontarians are unable to see their primary care provider on the same day or next day when they are sick.

The median time for people in the community waiting for a long-term care bed is 111 days.

Wait times for certain surgeries are improving, but many targets have still not been met.

Although we need to do a better job in many areas, it’s important to also recognize that there is a lot to celebrate. Here are a few of the other reasons that make me proud to say I live, work, and receive care in Ontario:

Ontarians overall are healthier than they’ve even been before, with life expectancy improving by a year to 81.5 years (the second highest in the country, behind British Columbia).

Two-thirds of Ontarians rating their health as “excellent” or “very good.”

Many areas of Ontario’s health system are performing better than they were five and 10 years ago.

On the cover of the report, we feature Ilona Taylor, a 70-year-old from Toronto who shared one of her stories. She’s riding her bike, one of her favourite ways to stay in shape. What you can’t see behind her smile is the fact that she recently had two hip replacements. Ilona is one of the many patient voices featured in Measuring Up. I have often written and spoken about the importance of understanding quality in health care through the voice of patients and families. Measuring Up contains several patient, provider and caregiver stories, just like Ilona’s, that work to bring perspectives and insights that data cannot.

During Ilona’s wait to see a surgeon, she says she was in “unbearable pain.” However, once she received her surgery date, nearly a year after she had asked for a referral, she was thrilled. “The surgeon was a true master of his craft,” she tells us. When her second hip gave out, she faced the same story, with wait times so long she asked the receptionist at her surgeon’s office to be placed on the standby list, ready to drop everything at the soonest cancellation. “I felt desperate,” she recalls, wondering whether she’d be “lucky enough” to get a return call. Then she tells us she thought, “Why does my health care depend on luck?”

People should not feel that their health care depends on luck. It also should not depend on where you live, and yet we saw significant differences in health and health care for Ontarians across the province. For example there is substantial regional variation in the percentage of home care patients with complex needs who receive their personal support services visit within the five-day target. We also know that Ontarians in the north have twice the rate of premature avoidable death than those in some other areas of the province.

This is one of the many reasons that it’s imperative to monitor and measure the quality of health care in Ontario. All of us, like Ilona, want to have a top-quality health system that is there for us when and where we need it.

I hope the report will spark new conversations in health care and add urgency to current ones. The report should be living document that forces us to ask hard questions, leads to new knowledge and guides change.